运动性高血压与动脉硬化和早期肾损害的相关性

Correlation of exercise hypertension with arteriosclerosis and early renal damage in patients with essential hypertension

目的 探讨原发性高血压患者中运动性高血压与动脉硬化及早期肾损害的关系。方法 选择原发性高血压患者105例,根据Bruce方案行次极量跑台运动负荷试验,依据次极量运动时收缩压(SBP)分为运动性高血压组(次极量运动时SBP≥200 mmHg,H组)和运动血压正常组(次极量运动时SBP<200 mmHg,N组),两组分别为46例和59例,均行血脂、肾功能、血糖、高敏C-反应蛋白(hs-CRP)、踝臂脉搏波传导速度(baPWV)、颈动脉内膜中层厚度(IMT)及尿微量白蛋白/肌酐(UACR)的检测,baPWV、IMT和UACR分别作为反映动脉硬化和早期肾损害的指标。结果 与N组比较,H组的BMI(P<0.01)、高血压家族史(P<0.05)、吸烟史(P<0.05)、LDLC(P<0.01)、hs-CRP(P<0.05)、baPWV(P<0.01)、IMT(P<0.05)与UACR(P<0.05)均显著升高;与N组比较,H组静息SBP升高(P<0.05),次极量运动时SBP、次极量运动时PP、运动后6 min SBP、运动后6 min PP均升高(均P<0.01);二元Logistic回归结果显示,静息SBP(P<0.05)、吸烟史(P<0.05)、BMI(P<0.01)、hs-CRP(P<0.05)与baPWV(P<0.01)共5个指标与发生运动性高血压之间存在显著正相关关系,而且是影响发生运动性高血压的独立危险因素。次极量运动时SBP与LDL-C(r=0.343,P<0.01)、hs-CRP(r=0.285,P<0.01)、BMI(r=0.294,P<0.01)与baPWV(r=0.371,P<0.01)均呈正相关关系。结论 在原发性高血压患者中,运动性高血压患者较运动血压正常患者的动脉硬化及早期肾损害更显著,应尽早发现运动性高血压并进行积极干预。

AIM To investigate the relationship between exercise hypertension and arteriosclerosis and early renal damage in patients with essential hypertension. METHODS A total of 105 patients with essential hypertension were enrolled in the study. According to Bruce’s protocol, the submaximal running table exercise load test was performed and according to their systolic blood pressure(SBP) at submaximal exercise, the patients were divided into exercise hypertension group(SBP during subextreme exercise ≥ 200mmHg, H group) and the normalexercise blood pressure group(SBP during subextreme exercise<200mmHg, N group). Blood lipids, kidney function, fasting blood glucose, high-sensitivity C-reactive protein(hs-CRP), brachial-ankle pulse wave velocity(baPWV), intima-media thickness(IMT), urinary albumincreatinin ration(UACR), baPWV and UACR were detected in all the patients, which served as indicators of arteriosclerosis and early renal damage. RESULTS Compared with group n, BMI(P<0.01), family history of hypertension(P<0.05), smoking history(P<0.05), LDL-C(P<0.01), hs CRP(P<0.05), baPWV(P<0.01), IMT(P<0.05) and UACR(P<0.05) in group H were significantly increased;Compared with group n, resting SBP in group H increased(P<0.05), SBP during submaximal exercise, PP during submaximal exercise, SBP 6 min after exercise and PP 6 min after exercise increased(all P<0.01);The results of binary logistic regression showed that there was a significant positive correlation between resting SBP(P<0.05), smoking history(P<0.05), BMI(P<0.01), hs CRP(P<0.05) and baPWV(P<0.01),and it was an independent risk factor affecting the occurrence of exercise-induced hypertension. SBP was positively correlated with LDL-C(r=0.343, P<0.01), hs CRP(r=0.285, P<0.01), BMI(r=0.294, P<0.01)and baPWV(r=0.371, P<0.01). CONCLUSION Among patients with essential hypertension, patients with exercise hypertension have more significant arteriosclerosis and early renal damage than patients with normal exercise hypertension. Exercise hypertension should be found as soon as possible and actively intervened.